Severe blunt trauma of the liver: study of mortality factors

One hundred three victims of blunt trauma of the liver with serious hepatic lesions (classes III through V of Moore's classification) were seen over a period of 18 years, the total duration of this retrospective study being divided in two: 1973-1981 and 1982-1990. During the first period, indications for hepatic resection were extensive (56% of all surgical procedures), and overall perioperative mortality was 24%. Preference was shown for conservative treatment during the second period (71% of patients) and there was an increase in perioperative mortality to 34%. This increase was not attributable to the decrease in the number of excisions but rather to an increase in the severity of hepatic lesions between the two periods (the rate of class V lesions rising from 17% to 26% of cases) and the rate of multiple trauma (rising from 41% to 95%), with mortality linked to the presence of extra-abdominal lesions rising from 20% to 50% of all deaths. These results may bring into question the validity of conservative treatment for liver trauma at the present time.